Hopes that a product containing nonoxynol-9 (N-9)—the active ingredient in most spermicides—could also protect women against HIV and other sexually transmitted diseases (STDs) were dashed following the release of a study at the 13th International AIDS Conference in Durban, South Africa, in July. Since N-9 kills HIV as well as bacteria that cause several STDs in the test tube, researchers had hoped that COL-1492, more commonly known as Advantage-S, could be used as a microbicide. Over a four-year period, they tested the product against a placebo in a study involving 990 sex workers in four developing countries.However, preliminary study results indicate that COL-1492, rather than protecting against HIV transmission, may actually increase the risk of infection, possibly by creating small lesions in the vaginal wall that make women more vulnerable. Still, important questions remain unanswered. While there clearly was a higher rate of HIV infection in the group of women using COL-1492 than in the group using Replens, a vaginal moisturizer, it is unclear whether COL-1492 increases susceptibility or Replens is protective, or a combination of both. Furthermore, it is also unclear whether and to what extent the frequency of COL-1492 use among the sex workers—who reported an average of 3.6 partners a day—may have been a contributing factor. Just what the study's findings mean for the continuation of other U.S.-funded studies involving N-9—and for women's use of spermicides containing N-9—remains to be seen. Experts will gather at the end of the year at the World Health Organization to review the status of N-9 and what messages women should be given regarding the use of spermicides that contain it.
Meanwhile, the COL-1492 trial results have attracted the attention of reproductive rights opponents Reps. Tom A. Coburn (R-OK) and Joe Pitts (R-PA). In August, they requested that the General Accounting Office (GAO) investigate the federal government's involvement with the purchase and distribution of condoms containing N-9. Specifically, they have asked GAO to determine the numbers of condoms with N-9 purchased either directly or indirectly by the federal government and distributed domestically and internationally. The request also asks GAO to determine what harm, in terms of new HIV infections, may have been caused by such distribution.